Inclusive Review on Existing Treatment and Management Modalities for COVID-19

*Jalpa Suthar and Jhanvi Patel*

## **Abstract**

COVID 19 is widely regarded as one of the worst pandemics of the twenty-first century. The World Health Organization (WHO) named the viral infection caused by the new coronavirus (COVID-19), which was first reported in December 2019, as severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV2), and it became a cause of death for many all over the world. As a result, a unique inquiry and clinical trial to find a solution for this catastrophic pandemic disease is under way. To manage and eradicate the disease, effective vaccinations and antiviral therapies are urgently needed. There were no treatments or vaccines available for this fatal virus at first, but several medications that are used to treat other diseases are now being used to treat Covid19. Remdesivir has been licenced for therapy since it has shown to shorten hospital stays. Corticosteroids reduced mortality in patients requiring oxygen supplementation or mechanical ventilation. The purpose of this review is to make readers aware of the possible efficacy and availability treatment for this viral infection.

**Keywords:** COVID-19, severe acute respiratory syndrome, corticosteroids, remdesivir, first wave, second wave

## **1. Introduction**

Covid-19 which is also known as novel coronavirus pneumonia firstly encountered in Wuhan, China in December 2019. The WHO Emergency committee declared a global health emergency on 30 January 2020 based on the growing case rates of covid-19 at Chinese and international locations [1]. This virus spread was so rapid that after 2 weeks from the first case diagnosed, 1000 patients were tested positive and the number of positive cases reached over 30,000 and 2500 deaths by 18, March 2020 [2].

The rate at which transmission of nCoV19 among the human is increasing than SARS CoV1 and MERS CoV, one of the group of international committee on taxonomy of virus (ICTV) named as coronaviridae study group (CSG) renamed as SARS CoV2, while WHO named as Coronavirus disease 2019 (COVID-19) [3]. Structurally SARS CoV2 contains single strand RNA [4] of which two third part of RNA is located in open reading frame (ORF) which include polyproteins and non-structural protein for viral cycle [3]. There are other structural protein which are encoded by ORF's like

spike glycoprotein (S), enveloped protein (E), matrix protein (M) and nucleocapsid protein (N). S protein of virus attached to host cell's receptor is present on the angiotensin converting enzyme 2 (ACE2) [5] from which SARS CoV2 passes through the mucous membrane of respiratory tract from which it enter to lungs then to systemic circulation through which it could target organ such as heart, brain, renal, lungs, GIT [3]. Then after entering into the cell, it gets replicated using protein such as chymotrypsin(proteases) and RNA polymerase.

The number of COVID-19 cases in second wave was much higher than the first wave of COVID-19. There were several factors responsible for the same. There are some clear distinctions between the first and second waves which are shown in **Table 1**. Paediatric and younger people, as well as older people, got infected in the second wave. COVID 2nd wave symptoms were extremely varied [6].

From an Indian standpoint, things moved slowly initially, with the first cases showing in February 2020. The lockdown had its drawbacks, in that it controlled the disease to a certain level in the hopes of a few treatments fighting against the virus. Hydroxychloroquine, azithromycin, favipiravir, an antiviral, and ivermectin, an anthelminthic, were being used during the start of the pandemic in India [7].

The majority of COVID-19 patients had mild-to-moderate symptoms and were treated by qualified clinicians outside of the hospital. In India, a typical COVID-19 prescription contains azithromycin, doxycycline, ivermectin, hydroxychloroquine, vitamin C, vitamin D, zinc, acetylcysteine, and budesonide inhalation or dexamethasone [8].

Despite not being indicated for COVID-19 by any major standards, the antiviral favipiravir became India's best-selling medicine in April 2021. Despite the advice of most international expert panels, anticoagulants like rivaroxaban were prescribed in outpatient settings, even for patients with no elevated thrombotic risk. Antibiotics with a broad spectrum of action are introduced under the pretence of treating secondary infections [8].

There has never been a poly-prescription of the mentioned medications previously. It's unclear how these pharmaceuticals interact with one another (or with medications administered for pre-existing problems). It becomes difficult to tell whether a new symptom is caused by COVID-19 progression, an adverse drug reaction, or a new consequence [8].

Due to structural similarities of SARS CoV2 to HIV, Hepatitis B, C the drugs used for the treatment of Hepatitis C virus [4] i.e. remdesivir is also used in SARS CoV2 as antiviral agents. Hence nucleoside analogues HIV proteases inhibitors (also RNA Polymerase) may be useful in COVID 19. On the other hand the second antiviral drug used in COVID treatment is FAVIPIRAVIR which is a purine based analogue [9] and RNA dependent RNA polymerase (RdRp) inhibitors which will inhibit RdRp for transcription and replication of viral genomes [3]. An another purine nucleoside analogue ribavirin, inhibits the activity of enzyme IMPDH [9] (Inosine-5-monophosphate dehydrogenase) which leads to the suppression of the cellular DNA and mRNA which lead to suppression of protein synthesis, due to deceased level of the intracellular guanosine triphosphate pool.

Apart from this other two methods were also used for hindering the replication which included immune modulation where convalescent plasma therapy was used [10] and viral entry inhibition which was achieved by drug hydroxychloroquine (HCQ ) [9]. Hydroxychloroquine and chloroquine which are anti-malarial agents with anti-inflammatory activities, can produce immune modulatory effect too, therefore

*Inclusive Review on Existing Treatment and Management Modalities for COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.106011*


#### **Table 1.**

*Differences between the first and the second wave of COVID-19 in India.*

a useful option for COVID 19 management. HCQ is known to demonstrate high potency inhibition of SARS CoV 2 virus in invitro studies. Besides this, corticosteroids also showed a tendency to reduce or prevent the systemic inflammation seen in COVID 19 patients [9]. Additionally many other drugs have also been selected for managing COVID 19 infection like Azithromycin (as antibiotics) lopinavir-ritonavir, interferon (antiviral drugs) multivitamins (vitamin D, vitamin C, and zinc) [3, 4, 9]. The supportive treatments included non-pharmacological approaches.

The C reactive protein and serum albumin have shown independent prognostic marker along with the age, maximum body temperature, smoking status and respiratory failure [11]. The immune response of the patients is weakened by inadequate nutrition. This shows that the nutritional derangements should be systematically managed in patients suffering from coronavirus. Besides giving the medicines or drugs when the patient's body is not responding to medications the other therapy used was convalescent plasma therapy where the plasma from recovered patients was ejected out and given to the infected one [12]. Vaccination helped to improve the immune system of individuals [13].

The review emphasis on the comprehensive overview on various treatment modalities available for the management of Covid-19.
